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PHARMACOLOGY I > corticosteroids > Flashcards

corticosteroids Flashcards

1
Q

what stimulates the zona glomerulosa to produce Aldosterone

A

Angiotensin II & K+

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2
Q

what stimulates the zona fasciculata & what does it produce

A

ACTH
cortisol

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3
Q

what does the zona reticularis produce

A

Adrenal androgens

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4
Q

what are cortisol & aldosterone released from

A

Adrenal cortex

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5
Q

what stimulates the release of Cortisol & aldosterone from the adrenal cortex

A

ACTH

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6
Q

what does aldosterone do

A

increases Na and H20 retention
increases K+ excretion

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7
Q

Glucocorticoids are anti- ?

A

inflammatory

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8
Q

how do glucocorticoids counter the effect of insulin

A
  • increase circulating amino acids
  • increase circulating fatty acids
  • increases gluconeogenesis
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9
Q

what is the effect of glucocorticoids on thyroid hormones

A

decreases TSH and therefore decreases thyroid hormone

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10
Q

what is the affect of glucocorticoids on ACTH

A

decreases ACTH via negative feedback on CRH

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11
Q

what is the number one cause of hypoadrenocorticism (Addison’s)

A

autoimmune disorder

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12
Q

what are the causes of hypoadrenocorticism

A
  • Primary autoimmune disorder (90%)
  • iatrogenic
  • neoplastic (pituitary tumor destroys ACTH production)
  • breed predisposition
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13
Q

gradual process that presents acutely - signs become apparent with 90% loss of adrenal cortex

A

hypoadrenocorticism
signs are vague: poor BCS, weight loss, lethargy

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14
Q

severe signs of hypoadrenocorticism

A
  • Bradycardia
  • hypovolemic shock
  • anemia
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15
Q

how do Na, K, Cl levels present in a hypoadrenocorticism patient

A
  • hyperkalemia
  • hyponatremia
  • hypochloremia
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16
Q

glucocorticoid absorbed poorly in feline and equines

A

prednisone

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17
Q

glucocorticoids are _____ soluble & therefore are distributed widely

A

lipid

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18
Q

glucocorticoids are bound in plasma by ______ & ________

A

albumin and corticosteroid binding globulin

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19
Q

prednisone & cortisone are both ?

A

prodrugs
prednisone –> prednisolone
cortisone –> hydrocortisone

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20
Q

prednisone and cortisone are bad choices for what patients and why

A

prednisone - cats b/c can’t metabolize
animals in liver failure won’t metabolize either drug

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21
Q

how are glucocorticoids useful in the treatment of osteoarthritis

A

they reduce production of PGE2 by synoviocytes and chondrocytes & suppress production of IL-1 and TNF-alpha all of which contribute to cartilage breakdown

22
Q

triamcinolone

A

labeled for use in horses
(musculoskeletal/joint inj)

23
Q

isoflupredone

A

labeled for use in swine & cows
(musculoskeletal/joint inj)

24
Q

flumethasone

A

labeled for use in horses & dogs
(musculoskeletal/joint inj)

25
Q

methylprednisolone & betamethasone

A

ELU
(musculoskeletal/joint inj)

26
Q

adverse effects of…
- triamcinolone
- isoflupredone
- flumethasone
- methylprednisolone and betamethasone

A
  • muscle atrophy (increases circling amino acids)
  • osteoporosis (increases Ca excretion annd inhibits osteoblast function)
  • inhibits fibrocartilage growth (don’t use in growing animals)
27
Q

what are the major reasons to NOT USE glucocorticoids in treatment of integument conditions

A
  • cutaneous food allergies
  • infectious or parasitic (bacteria/fungal infections, flea allergy dermatitis)
    *
28
Q

what drug is used for the treatment of IBS

A

Prednisolone

29
Q

what are the drug options for treatment of bovine ketosis

A

both: induce gluconeogenesis
* dexamethasone (abortant)
* isoflupredone (may cause hypokalemia, less risk for abortion)

30
Q

what are the causes of hyperadrenocorticism (mostly dogs)

A
  • pituitary tumors (85%)
  • adrenocortical tumors (15%)
  • iatrogenic (glucocorticoids)
31
Q

effect of glucocorticoids on the cardiovascular system

A

vasoconstriction b/c increased sensitivity to sympathetic stimulation
hypervolemia due to aldosterone causing retention of Na and H2O

Hypervolemia –> increased BP, compensatory decrease in ADH secretion, dilute urine, PU/PD

32
Q

Glucocorticoids antagonize insulin, leading to ?

A

hyperglycemia; increases gluconeogenesis

33
Q

effects of glucocorticoids on circulating fatty acids

A

increases circulating FAs, leads to fat redistribution that contributes to thin skin and potbelly

34
Q

why can hyperadrenocorticism cause gastric ulcers and colonic perforation

A

decreased PLA2 causes a reduction in prostagladin production, prostaglandin helps maintian mucous integrity

35
Q

under what cicumstances can hyperadrenocorticism lead to adrenal atrophy

A

only with iatrogenic hyperadrenocorticism

36
Q

Cosyntropin

A

ACTH stimulation test
(peaks effects occur at 30 min for hoses, 60 min for dogs)
hyperadrenocorticism would cause an above average spike in serum cortisol levels post Cosyntropin admin

37
Q

how can iatrogenic hyperadrenocorticism be confirmed

A

no response to the cosyntropin ACTH stimulation test confirms adrenal insufficiency and iatrogenic hyperadrenocorticism

38
Q

what is the low dose dexamethasone suppression test

A

**Dexamethasone suppresses ACTH and CRH si it should reduce circulating cortisol **
measured at 4 and 8hrs post admin
if cortisol levels are still high at hour 8 –> hyperadrenocorticism

39
Q

what is the drug of choice for small animal hyperadrenocorticism

A

Trilostane

40
Q

what is the MOA of trilostane

A

competitive inhibitor of 3β-hydroxysteroid dehydrogenase
reduces but doesn’t eliminate the synthesis of corticosteroids

41
Q

what are the adverse effects of Trilostane

A
  • hypocortisolemia - lethargy, anorexia
  • hyponatremia
  • GI upset (D/V+)
  • adrenal gland necrosis (super rare)
42
Q

drug that destroys the zona reticularis and fasciculata but doesn’t reduce mineralcorticoid production

A

Mitotane

43
Q

Equine cushings disease (PPID) cause

A

tumor in pars intermedia causes pressure atrophy of dopaminergic neurons in the hypothalamus
reduces inhibition of ACTH release = cortisol release

44
Q

treatment for PPID in horses

A

Pergolide mesylate
highly potent dopamine receptor agonist

45
Q

what are the to go home corticosteroids (4 to go home)

A
  • Pred
  • Methylpred
  • Triamcinolone
  • Fludrocortisone
46
Q

Emergency corticosteroids (IV admin)

A
  • Pred
  • methylpred
  • dexamethasone
47
Q

what is the strongest mineralcorticoid

A

Fludrocortisone

48
Q

what is the strongest glucocorticoid

A

dexamethasone

49
Q

what mineralcorticoid has the longest duration

A

Deoxy pivilate (IM)
one month!

50
Q

what corticosteroids are glucocorticoids only

A
  • Triamcinolone
  • Dexamethasone
51
Q

what corticosteroids are mineralcorticoids only

A
  • deoxy pivilate
  • aldosterone

PHARMACOLOGY I (21 decks)

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